Inpatient or Outpatient?

Learn How Your Hospital Status Affects Insurance

Any time you visit a hospital for services, the hospital gives you a status, that describes the care you need, to your insurance provider. There are two types of hospital statuses:

• Outpatient status includes emergency department visits, observation services, X-rays, tests, and some surgeries. You may be an outpatient even if you stay overnight.
• Inpatient status begins when a doctor writes an order to admit you to the hospital. This can be planned (like a hip surgery) or unplanned (like an emergency department visit).

Sometimes, you may have to stay in the emergency department or another part of the hospital for observation. Observation is a type of outpatient service your doctor may use to help decide whether to admit you as an inpatient or to discharge you. Observation can only last for a certain amount of time.

Hospital status affects all insurances, including private, Medicare and Medicaid. Some insurance providers will charge inpatient and outpatient hospital services separately, and how much some services cost may change depending on your status. Remember, your doctors and nurses will not treat you differently because of your hospital status. It only affects how much your insurance pays for services.

Medicare covers different amounts of your hospital stay, depending on whether you’re an inpatient or outpatient. If you are an inpatient, a combination of Medicare Part A and Part B covers your care. If you are an outpatient, Medicare Part B covers hospital and most doctor services, but not all medicines. You will need to pay out of pocket for some medicines, then submit a claim to your prescription coverage plan (like Medicare Part D) for a refund.

If you don’t know your hospital status, ask your doctor or nurse.